ANDHRA PRADESH STATE WAKF BOARD

APPLICATION FORM FOR DIVORCE CERTIFICATE

To: Price Rs. 1/-

The Chief Executive Officer, Issue No.__________
A.P.State Wakf Board,
Hyderabad. Dated: ____________

Sir,
(TO BE FILLED IN CAPITAL LETTERS)
Sub: - Issue of Divorce Certificate: - Reg.
I am enclosing herewith- necessary record for issue of Divorce Certificate.
PARTICULARS OF THE BRIDGE GROOM (DULHA) AS PER RECORD

N A M E :

FATHER’S NAME :

DATE OF BIRTH : ( ) OR AGE ( ) YEARS

OCCUPATION :

RESIDENT OF :

PARTICULARS OF BRIDE (DULHAN) AS PER RECORD

N A M E :

FATHER’S NAME :

DATE OF BIRTH : ( ) OR AGE ( ) YEARS

OCCUPATION :

RESIDENT OF :

DATE OF DIVORCE :

Yours faithfully
Name:
(Receiver’s Signature) address:
 ( FOR OFFICE USE ONLY)

(VERIFIED AND FOUND CORRECT)

QAZAT BEARING NO.______________

NUMBER OF CERTIFICATE: ( ) URGENT / ORDINARY

RECEIPT NO: AMOUNT RS. DATE:

CLERK N.Q. ACCOUNT CHIEF EXECUTIVE

OFFICER OFFICER